This month’s issue of Nursing Notes looks at the rewards and challenges presented by a career in Oncology Nursing. This month, I chatted with Oncology Nurse Jacquelyn Grandt, Program Director, Outpatient Oncology Services at Long Beach Memorial Medical Center in California. Jackie is featured in this month’s Nursing Notes newsletter as our “Get to Know” Nurse.

Jamie: Jackie, we’re really excited to have you on the show this month. We’re talking about oncology nursing and you’re our featured “Get to Know Nurse.” We wanted to really a get chance to chat with you and find out a little bit about how you got started in nursing. Did you always want to be a nurse as you were growing up or is this something you moved into as you got into college and made that decision?

Jackie: First off, thank you also for inviting me to be your guest speaker. Actually, as a child, I enjoyed playing doctor and nurse. I had three sisters. I was the second oldest. My oldest sister was always the doctor. I was always the nurse. My two younger sisters, they always were our patients. I really enjoyed doing the nursing aspect. I enjoyed doing bandages and checking temperatures and, of course, all with our “Play Doctor” set as a kid. Even as a child, that point on, I just said this is something I really enjoyed doing. This is something I want to go into. When I graduated from high school, I knew I wanted to be a nurse and set it as a goal and worked on accomplishing that.

Jamie: What was your pathway to becoming an RN? Were you in a diploma program? Did you go right into BSN program? How did that progress for you?

Jackie: Well, that’s a good question. Actually, I was in an ADN program to begin with. Initially, I started in a BSN program but then I got married. I relocated and in relocating was then an out-of-state resident and had to wait for a while to establish residency to get into a college. When I came to California, I realized they had ADN programs which, back when I went to nursing school, were kind of new at the time. So I decided, “Hey, this might work for me.” So I started Junior College within six months of getting married out here in California and then went through the ADN program. My goal was always to get my BSN. That didn’t happen however until about 22 years into my nursing career. At that time, it worked and I went back and I got my BSN. Now after I finished my BSN – that was really my goal only to do that – I was actually working with a very wonderful medical oncologist at that time who encouraged me to go on and pursue a nurse practitioning certification and degree. Immediately after finishing my BSN, I went right into an NP program then completed that within a few years after that. That’s kind of my career progression entertainment.

Jamie: That’s fascinating. It’s always important I think for us to point out that no matter where you are in your nursing, in education, there’s always an opportunity no matter where you are to move on and further your education. You’re not the only nurse I speak to that says, “Well, I didn’t get my BSN until I’ve been in for 20 years, 25 years.” I’m glad to hear you say that because I think it encourages a lot of nurses out there to continue to focus on when they have the opportunity to move forward.

Jackie: Yes, that’s very true. Probably one of the things in working with other nurses over the years, I’ve worked with medical assistants and LVNs and even RNs who I’ve encouraged to just know my story and know how I did it and know that, just like what you said, at any point you can get back in it and go on. Even today with the programs that now will take people who have BAs or BSs and other subjects and put them into nursing as well is wonderful.

Jamie: Now how did you choose oncology nursing as the specialty that you found yourself in now? Was that something you moved into immediately or is it something you found after you’d been nursing in a hospital or another setting for a while?

Jackie: Actually, it was something I went right into. My very last rotation in nursing school was on an in-patient hematology-oncology unit. Then when I got licensing I was actually hired to work on that unit. It just felt really right. It was a very rewarding and a very challenging area to work in. As a new nurse I can say that working in oncology, and even today I’m sure in an in-patient setting, it’s very, very challenging from the perspective of there’s a lot to learn beyond what you learned in nursing school relative to this specific specialty. I found that challenging and I found the opportunity to grow in every aspect of physical and psycho-social care of these patients which is what I really loved.

Jamie: Oncology nursing, the whole field of cancer care has really changed so much over the last 20 to 30 years. The ways we’ve been able to treat patients and the survivability of many cancers has changed greatly. What has been one of the things that impacted your patients the most over the course of your career?

Jackie: Probably the significant change in the way we treat patients. Today, chemotherapy and radiation therapy and surgery are not used singly or independently. It’s really a combination of those therapies so it is multi-modality therapy that patients get today. That’s very challenging for clinicians to implement as well as for patients to traverse through to get the quality care that they need and to complete their therapy and treatment in a timely fashion. That to me is very challenging, that I find with that change has been a significant change in a way we as nurses need to look at these patients. We need to make sure that every opportunity for them to get evaluations by the surgeon, the medical oncologist, the radiation therapy. All those things take place so that when they make a decision regarding their treatment, they’re making a completely-informed decision. I think that’s a nursing responsibility.

Jamie: Certainly bringing that coordinated care approach together is something that nurses are really in a unique position to do in their care for patients.

Jackie: Yes, very much so. I know that many nurses out there will probably say that they are already doing that and I think that that’s very true. There is a whole new group of nursing out there that’s developing and that’s the nurse navigator role and part of my position at Long Beach Memorial Medical Center in the cancer program is developing a navigator program for our program.

Jamie: Tell me a little bit about that nurse navigator program because it is so new. There are many nurses out there that don’t understand in terms of a patient, like a cancer patient, what a nurse navigator does for them.

Jackie: Yes. The nurse navigator, actually, the position varies from place to place. The development of that position has varied. Initially, nurse navigation started out with lay people and social workers and then now has traversed to involving, I think more greatly, nursing. The level of nursing varies. You can see RNs, advanced practice nurses both helping to navigate patients.
It’s still a developing position but navigation in and of itself the way that I see it and understand it is it’s really helping the patient from the time they’re diagnosed to the whole course of whatever treatment their treatment may involve be it surgery, chemotherapy, radiation and then continuing to follow the patient after they finish their treatment through survivorship. Today survivorship is a big component in cancer care. As you stated early on, our patients are doing better and living longer with our newer treatments. I think survivorship is going to be another big role that is developing in the years ahead. That’s going to be very important for oncology patients.

Jamie: Whenever we talk about cancer, we have to think about those patients that are not going to survive. Sometimes they don’t. That’s a function of what we do. What do you have to say to someone that is concerned about having a group of patients where you know a percentage of them are going to pass away as a result of their illness? What is your advice to new oncology nurses about dealing with those kind of things?

Jackie: Well, good question. Yes, a good percentage of patient years ago when I first started oncology nursing do not survive. Yes, I have to say initially it was very, very difficult. But there’s so much that nursing and nurses can learn from a patient who is traversing the last part of their life. Being involved and being a part of that is a big learning process and that I don’t think you ever accept that this is just the result of the cancer treatment but that it really gives you growth to understand and with each situation you develop new skills that can help you with the next patient. I think today with the focus too in oncology, on palliative care, that a lot of what in the past really wasn’t addressed with patients and families today is a very active part of the whole cancer treatment process. There’s so many more parts to oncology nursing today than when I first started with having palliative care hospice, survivorship. Those things didn’t exist 37 years ago when I started but they’re all key things that have grown out of nursing I really feel and nurses’ assessment of the care of oncology patients and are now really helped the oncology nurse be able to better manage and take care of their patients.

Jamie: You mentioned families. A few months ago, we talked to pediatric nurses and that was something we discussed. It was that there’s really more than just the patient to educate and treat. Certainly that seems to be the case with cancer patients as they’re facing their mortality. They have caregivers that are needed in the home. Certainly it’s important to find out what resources that patient has whether it’s family or friends or community resources.

Jackie: Yes, that’s very true. Like the way it is today, just like what you said, people not having extended family in the immediate area, as soon as the patient becomes your patient and really getting to know the patient and their support system and what they have available and immediately tapping in to what will be their resources over the course of their treatment is very, very important. Working with social workers and your psycho-social team and really having a strong psycho-social team is absolutely important today. I can say at Long Beach Memorial I’m very privileged to be working with a very wonderful psycho-social team that includes psychiatrists, social workers, a life coach. We have dietary help. We have rehab help. All those things which were so important in caring for oncology patients.

Jamie: I know oncology nursing has a very active society associated with it. Can you tell us a little bit about how being part of that and being involved with that association, the Oncology Nursing Society, has helped support your career through the years and enriched your ability to care for your patients?

Jackie: Yes. The Oncology Nursing Society has been a major part of my career. A lot of the time in my career has been spent in private practices and in practices where I was maybe the only nurse. Having connections and having resources and having the ability to get knowledge about new therapies, new approaches to managing patients and stuff was something that I didn’t have a team to share with. So I, very early on my career and probably four years after being in oncology nurse, joined the Oncology Nursing Society. That was one of the most valuable things I did in my career. It helped me to develop a network of colleagues and friends that over in the course of the year I’ve been available to call upon when I’ve been in situations and in practices where I maybe was the sole nurse to discuss, “How would you do this?” or “What should we be thinking about?” I can’t speak more highly of one organization than the Oncology Nursing Society.

Jamie: I think the nurse specialty associations like the Oncology Nursing Society are one of the most underutilized resources in nursing. I always try to bring that in to play because I think it’s important for those nurses out there to understand that they’re not alone especially in your situation where you’re maybe one or two nurses in a private practice but you have other nurses that are doing the same things all over the country and all around the world that have come up with a solution to something you need.

Jackie: That’s exactly right. That’s what I always found. It’s funny, once you develop those relationships with those nurses and network with them be it locally or nationally like you said, it’s just an awesome feeling to know that they are there. The Oncology Nursing Society has so many ways for you to identify and connect with people in your area which is just great.

Jamie: For that nurse or nursing student who’s sitting there listening to this, what would be some key pieces of advice you would give them as they may be considering becoming an oncology nurse?

Jackie: Well, I would definitely encourage them to look at the oncology nursing website. Go on that website and look at what resources are available. They may feel that they don’t have the skills and the knowledge to become involved in oncology nursing. But again in doing that they will see that there’s a lot of resources that they’ll have at their fingertips. That they can use to enter that field. I would encourage them to try to find someone who’s been on oncology nursing for a while to connect and have as a mentor. That’s something that’s very common to see today. That’s not something that existed when I first started and it’s something that I would encourage a new oncology nurse to do. In the course of my career, I’ve had nursing students that I have mentored or proctored during the time that they were going to school. It was really exciting and awesome to get to share my knowledge about oncology nursing with them and then to even see some of them go on to become oncology nurses as well. I encourage them to connect, to find somebody that is doing it and to really spend some time in the ONS website and even attend local chapter meetings if they can identify where those are at. You can usually do that on the website for ONS and get involved. If it’s something that you want to do and if you even have the slightest interest in, there’s a lot of knowledge that you can draw from.

Jamie: Jackie, I want to thank you very much for taking sometime to share your career as an oncology nurse with the listeners here at Nursing Notes Live.

Jackie: Thank you very much. I want to thank you for your time too. It has been an enjoyable experience.

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Don’t forget to check out the entire January, 2011 issue of Nursing Notes, featuring a look at treatment and care of patients by oncology nurses, including information on nurses’ impact on medication compliance, and a link to “A Day in the Life” video following Oncology Nurse Tanisha through her day caring for patients living with cancer. You can read the entire issue online at www.discovernursing.com and don’t forget to catch our other Nursing Notes Live episode this month where we brought together a group of working in the oncology field to talk about the unique challenges and common misconceptions about nursing care for cancer patients. You’ll find this and our other podcast episodes at www.NursingNotesLive.com and in the podcast area in iTunes.

Nursing Notes Live is an audio extension of the national award-winning monthly e-newsletter, Nursing Notes – which offers the latest industry news, trends and updates in nursing. You can subscribe to the e-newsletter at www.discovernursing.com. Each month’s Nursing Notes issue will be accompanied by a couple of episodes of Nursing Notes Live, which will expand on the content and provide you greater insights into the topics presented in the e-newsletter. Check out NursingNotesLive.com or visit iTunes to subscribe to all episodes of this podcast!